Employability assessment of computerized fatigue avoidance tool used with and without actigraphy among naval aircrew.

Background: Fatigue Avoidance Scheduling Tool (FAST) is a computerized fatigue prevention tool, which was developed based on a Bio-mathematical model called SAPTE (Sleep, Activity, Performance and Task Effectiveness). Similarly, actigraphy technology is used as a tool for sleep evaluation. This study was an attempt to assess the employability of FAST (both independently and integrated with actigraphy) for detecting operational fatigue by determining the 'Measures for diagnostic accuracy'. Methods: 103 pre-flight medical checks from 51 aircrew were evaluated to detect fatigue both clinically and by using objective measures (FAST and actigraphy integrated FAST). The 'measures of diagnostic accuracy' namely sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive (LR +ve), likelihood ratio negative (LR -ve) and Youden's Index were determined and compared. Results: The diagnostic measures for FAST were: sensitivity (68.4%), specificity (92.8%), PPV (68.4%), NPV (92.8%), LR+ve (9.5), LR-ve (0.34) and Youden's Index (0.61). For actigraphy integrated FAST these values were: sensitivity (84.2%), specificity (96.4%), PPV (94.2%), NPV (94.4%), LR+ve (23.5), LR-ve (0.16) and Youden's Index (0.80). Conclusion: The increase in sensitivity (from 68.4% to 84.2%), specificity (from 92.8% to 96.4%), PPV (from 68.4% to 94.2%), NPV (92.8% to 94.4%), LR+ve (9.5 to 23.5) and Youden's Index (0.61 to 0.80) indicated that actigraphy integrated FAST is a better screening tool in comparison to the independently employed FAST.

Maxillofacial trauma in ethnic minorities: has Brexit promoted an increase in violence and discrimination?

The main objective of this study was to evaluate whether the 2016 Brexit referendum has contributed to an increase in maxillofacial injuries specifically targeted against ethnic minority groups in the district of North London. The secondary objectives were to identify the most common types of injuries following the assaults and the number of patients admitted to hospital. A total of 1,391 people was assaulted between 1 January 2014 and 31 December 2018. They were classified into the following categories: White (62.4%), Asian (13.6%), Black/African-Caribbean (11.9%), Other (Arab) (9%) and Mixed Ethnic Group (3.2%). A shift in the proportion of ethnicities affected, rather than an increase in the overall number of injuries, was observed during the five-year period. A significant increase in assaults against individuals of Asian ethnicity (p<0.01) and against Croatians (p<0.01) was recorded between 2014 and 2018. Peaks in assaults against white non-British individuals and Romanians were also identified in 2017 (p=0.04 and p<0.01, respectively). Furthermore, the White British (p=0.02), Asian (p<0.01) ethnic groups and the Spanish, Romanian, Italian, Russian, Lithuanian, Albanian and Croatian (p<0.01) nationalities experienced a significantly disproportionate number of attacks compared to their population share in North London during this five-year period. The most common injuries were contusion, and fractures of the nasal bones and mandible at 24.2%, 17.1%, and 16.5%, respectively. A total of 415 patients (29.8%) required hospital admission for treatment and 47.6% received conservative treatment. The authors have concluded that the Brexit vote may have played an important role in increasing violence and hate crime against specific ethnic minorities.

Navigable Channel-Based Trans-Sulcal Resection of Third Ventricular Colloid Cysts: A Multicenter Retrospective Case Series and Review of the Literature.

BACKGROUND: Developments in frameless neuronavigation and tubular retractors hold the potential for minimizing iatrogenic injury to the overlying cortex and subcortical tracts, with improved access to the ventricular system. The objective of the present study was to evaluate the surgical outcomes after resection of third ventricular colloid cysts using an integrated neuronavigation and channel-based approach. METHODS: We performed a multicenter retrospective analysis of surgical Outcomes after surgical resection of third ventricular colloid cysts via a transtubular trans-sulcal approach. RESULTS: A total of 16 patients were included, with a mean age of 42 years (range, 23-62 years). The mean maximum diameter of cysts was 14 mm (range, 7-28 mm), and preoperative hydrocephalous was present in 12 patients (75%). Gross total resection was achieved in all 16 cases. Of the 12 patients, 4 (25%) had undergone septum pellucidotomy, in addition to cyst resection. No case had required conversion to open craniotomy. No perioperative mortalities occurred. Three patients (18.8%) had developed transient memory deficits, 1 of whom had also developed a pulmonary thromboembolism. The median length of hospital stay was 4 days (range, 2-18 days). All the patients reported resolution of preoperative symptoms at the 1-month follow-up examination. Only 1 patient (6.25%) had required insertion of a ventriculoperitoneal shunt. The median follow-up duration was 6.5 months (range, 3-24 months), and no recurrences were observed. CONCLUSION: Use of a channel-based navigable retractor provided a minimal trans-sulcal approach to third ventricular colloid cysts with the benefit of bimanual surgical control in an air medium for definitive resection of third ventricular colloid cysts.

Efficacy of C.E.R.A. in Routine Clinical Practice for Correction of Anaemia and Maintenance of the Haemoglobin Levels in CKD Patients not on Dialysis.

INTRODUCTION: C.E.R.A. reported effective correction of anaemia and was well tolerated in International studies on CKD patients not on dialysis. OBJECTIVE: The study aimed to describe the management of renal anaemia in CKD patients not on dialysis with C.E.R.A. in routine clinical practice in India. METHODS: This was a prospective, single-arm, open-label, multi-centre, non-interventional, Phase IV study which followed 108 CKD Stage III-IV patients, not on dialysis with Hb < 10 g/dL for correction of anaemia with C.E.R.A. RESULTS: Of the 108 patients with Hb < 10 g/dL at baseline, 83 (90.2%) patients achieved target Hb of 10-12 g/dL and the time taken to achieve correction of anaemia was 9.6 weeks ± 6.13 weeks in the Intent-to-treat population. Haemoglobin concentration increased from 8.59 ± 0.808 g/dL pre-therapy to 10.91 ± 0.634 g/dL post-therapy. The change in mean ± SD Hb value was 2.32 ± 0.174 g/dL. Maintenance of Hb levels within the target range of Hb 10 - 12 g/dL was observed in 78.2% of ITT and 80.8% of the PP population for mean duration of 16.69 weeks. Four patients (3.7%) experienced 5 AEs and 2 patients (1.9%) experienced 3 SAEs in the safety population. As per the treating physician none of the AEs or SAEs was considered related to study drug. There were no deaths reported. CONCLUSIONS: This study demonstrated successful correction of anaemia in Indian patients with C.E.R.A. treatment as well as maintenance of Hb levels within the target range. C.E.R.A. was well tolerated with no new safety concerns specific to the Indian population. The less frequent up to monthly dosing schedule of C.E.R.A. may offer clinicians and patients a simplified regimen of anaemia management as compared to traditional frequently administered (thrice weekly to once weekly) ESAs.